Although diets have been around for centuries, studies have shown that very few people experience sustainable changes in their health or weight. Worse, dieting is associated with weight cycling, disordered eating, eating disorders, and weight stigma. In short, diet culture is an outdated paradigm whose time is up! (Download references.)
Now we have a new kid on the diet culture block: GLP1s. So far, they appear to be more effective than dieting for weight loss, but the jury is still out on whether they are any more sustainable. Further, it is far too early too know about long term effects and safety. Still, I respect each individual’s choices in deciding what’s right for them.
What IS clear though: Diet culture, the belief that thinness (I would add, at any cost) automatically confers health, attractiveness, and well-being, is alive and thriving!
Diet culture is like antacids. Let me explain…
When I was in medical school a few decades ago(!), peptic ulcer disease (PUD) was believed to be caused by stress and excess stomach acid. Therefore, the treatment was a bland diet and antacids, which didn’t work very well. Later powerful acid blockers were developed. These treatments worked better, but the ulcers frequently relapsed and required repeated or chronic treatment.
Despite these ultimately ineffective therapies, the discovery by Barry Marshall and Robin Warren that most cases of PUD were caused by a bacterial infection was initially met with great skepticism, defensiveness and criticism. (This is a form of cognitive bias known as the Semmelweis Reflex.)
Marshall and Warren continued to challenge the dogma, even going so far as to intentionally infect themselves with H. pylori. It was well over a decade before it was widely accepted that PUD could be cured with a single round of triple therapy.
Aha! No wonder the old PUD treatment didn’t work: We were treating the symptoms, not the cause.
Marshall and Warren won a Nobel Prize in 2005 for their persistence in changing the paradigm, and millions of PUD sufferers have finally been cured!
Diet culture: An outdated paradigm
We’ve been at a similar crossroads with dieting, the antacids of our day.
Like using antacids for peptic ulcer disease, diets temporarily treat symptoms, not causes. Diets temporarily change behaviors, not the source of those behaviors. And worse, the restrictive rules that are part of every diet (see Signs your “eating plan” is really a diet) drive food noise and the very behaviors they claim to fix! As a result, the failure of diets had reinforced false narratives about body size, willpower, and “good food/bad food.”
And now, GLP1s can be thought of as the acid-blockers of our time. True, they are more effective at treating symptoms: alleviating food noise, suppressing appetite (haven’t we been here before?), and increasing fullness.
Yet, they still don’t address the underlying individual and cultural struggles with food and eating – which ironically, were at least in part caused by decades of dieting! Remember:
We can’t solve problems by using the same kind of thinking we used when we created them.
What is diet culture?
Let’s take a step back… The diet paradigm, also called diet culture, is the pervasive set of beliefs that thinness automatically confers health, attractiveness, and well-being. Diet culture, before GLP1s, implied that being (or becoming) thin was simply a matter of choosing “good” foods over “bad” foods (despite constantly changing definitions of good and bad foods). Conversations about miracle foods, time-limited eating and cheat days were commonplace and encouraged.
There was also an emphasis on doing the “right” amount and type of exercise to achieve the highly oversimplified “calories in vs. calories out” equation – in other words, exercising to earn the right to eat. In diet culture, exercise is punishment for eating and/or having the wrong body size or shape.
Weight stigma is often disguised as wanting to help people become healthier. Often “experts” resorted to blaming and and even shaming dieters when they quit the diet or started to weight cycle, even though that’s the known outcome for the vast majority of people. Shame and body-bashing has become a bonding experience for many chronic dieters.
Diet culture is so ubiquitous that many of my clients suffer from guilt about eating and physical activity even when they are not actively dieting. Ironically, these restrictive and shaming thoughts drive mindless and emotional eating, reinforcing diet culture’s belief that some people lack self-control.
And while GLP1s have helped change the narrative that diets work but people fail, diet culture was the perfect environment for GLP1s to swoop in and save the day! (Anyone need a Pepcid?)
A paradigm that’s too flawed to fix
“When ideas go unexamined and unchallenged for a long enough time, they become mythological and very, very powerful. They create conformity. They intimidate.” – E.L. Doctorow
As we’ve been saying for years: The diet and weight-based paradigms are flawed, yet so pervasive, millions of people are trapped in outdated beliefs about diets, weight, and ineffective restrictive behaviors, despite all the evidence that they have not moved the majority toward healthier, happier, more vibrant lives.
There is endless, tiresome debate in the medical literature and media about which diet work better, but none have shown lasting results.
Instead of questioning the entire foundation on which this failed paradigm was built, they are using this failure as the reason GLP1s are the “solution” to the problem diet culture created.
The shift away from diet culture
I was seeing many hopeful signs that a shift was finally taking place. More of my health and wellness professional colleagues were acknowledging the failure of the diet paradigm and were no longer preaching rule-following and motivation.
With the explosion of GLP1s, the murmur, “diets don’t work,” has reached a crescendo. We’ve been saying this for two and a half decades, so why did it take so long?
One explanation is that it’s difficult for “experts” caught up in the diet paradigm to see the need for a radical shift, particularly if their reputation, life’s work, and in some cases, financial security depend on keeping people trapped in the eat-repent-repeat cycle. I doubt most people who promote diet culture are malicious. It’s just that it’s so deeply embedded in our cultural norms, they couldn’t see the harm it was causing.
Those same experts now believe they’ve found the holy grail. Studies are showing difficult side effects—even death, worrisome muscle loss, malnutrition, and the need to stay on the medication chronically (even though we don’t have long term data). And oh, by the way, the package insert for each of the drugs says, “should be used with a reduced calorie meal plan and increased physical activity.”
Yes, the diet and weight-based paradigm is difficult to see through, much less break-through.
Time will tell, but in the meantime, diet culture is a paradigm that is too flawed to fix. The time is up.
A radical third option
The outdated and ineffective diet paradigm is a result of dichotomous thinking that presumes that if we don’t control eating behavior either through restriction or pharmaceuticals, people will be out of control.
But there is a third radical option: People can relearn to be in charge instead.
I’ve been speaking and writing about a non-restrictive, non-diet approach since 1999 when I founded Am I Hungry? Mindful Eating Programs and Training. In my book series, Eat What You Love, Love What You Eat, I guide readers through this paradigm shift one step at a time.
When eating, physical activity, and self-care are approached from a non-diet, weight-neutral, mindfulness-based paradigm instead, people are able to relearn to balance eating for enjoyment with eating for nourishment, rediscover joy in physical activity, and meet their true needs in more fulfilling, satisfying ways. In short, they heal their relationship with food and their bodies.
I’m the first to admit that although the concepts are simple, it’s not always easy to change longstanding beliefs. Without a doubt, mindful eating requires awareness, intention, trust, new skills, practice—and revolutionary thinking.
Yet countless mindful eating program participants and readers have changed the way they think about eating—even after decades of recurrent or chronic yo-yo dieting. Given the high GLP1 discontinuation rates, I predict we’ll see another wave of individuals finally ready to heal their relationship with food.
What’s the alternative? Argue for an outdated paradigm that obviously doesn’t work? Just continue to treat the symptoms? I’ve moved on.
This article was updated from a previous version.
If you enjoyed this article, here are three more to help you:
Dieting is like walking a tightrope
Mindful Eating with Health Issues: What If I Can’t Eat What I Love?
What is the difference between Am I Hungry? and intuitive eating or HAES?
